Welcome to the Therapy for Black Girls Podcast, a weekly conversation about mental health, personal development, and all the small decisions we can make to become the best possible versions of ourselves.

I'm your host, doctor Joy hard and Bradford, a licensed psychologist in Atlanta, Georgia.

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While I hope you love listening to and learning from the podcast, it is not meant to be a substitute for a relationship with a licensed mental health professional.

Hey, y'all, thanks so much for joining me for session four thirty two of the Therapy for Black Girls Podcast.

We'll get right into our conversation afterword from our sponsors.

Today, we're diving into a topic that's transforming how we understand public health education in this country, childhood trauma and its lifelong impact on the brain and body.

For decades, adverse childhood experiences are aces like abuse, neglect, or exposure to violence.

We're often seen as just social or emotional issues, but research has revealed the science of something much deeper.

These experiences can rewire a child's developing stress response system, leading to increased risk of chronic disease, mental health disorders, substance dependence, and even incarceration later in life.

Joining us today is someone who's pioneered the charge and translating that science into statewide action.

As California's very first Surgeon General, Nadine burg Harris helped put childhood trauma at the center of public health policy.

She not only trained tens of thousands of providers to screen for aces, but push for major changes like linking juvenile justice reforms to health equity.

Doctor burg Harris brings a clinician's insight and an advocates persistence to a conversation that challenges us to think bigger about prevention, healing, and what it really means to create environments that build holistically healthy and stable children.

If something resonates with you while enjoying our conversation, please share with us on social media using the hashtag TVG in Session, or join us over on our Patreon to talk more about the episode.

You can join us at community dot therapy for Blackgirls dot Com.

Here's our conversation.

Thank you so much for joining us today, Doctor ric Harris.

Oh, it's my pleasure.

I'm so excited to chat with you.

I feel like I remember seeing you years ago, I believe, on the Oprah Show and I was like, oh my gosh, this is such good work.

I'm so glad that she has discovered this and is talking more about acism.

I'm so honored to chat with you.

Yeah, thank you.

That was fun.

That was like a pinch me moment talking to Oprah.

I know it's a little crazy.

So you were You made history as California's first surgeon General and immediately got to work talking about childhood trauma and made that a statewide priority.

Can you talk about what it was like stepping into that role and why it felt important to address childhood trauma as your first priority.

That's so funny.

It's actually a funny story because when the Governor's office reached out to me about creating the role of California Surgeon in General, I was like seriously.

And also because I'm fundamentally an advocate, I came into my work really to help vulnerable communities and help vulnerable children.

And I remember when I sat down with Governor Newsom before I took the role, and I said, hey, listen, this is a big priority for me and he said.

One thing that actually just cooked me when I said I really wanted to have average childhood experiences and toxic stress be an area of focus, and not just the impact on health, but how it affects our society in a larger way.

He said to me, I'll do you one better.

We are moving the Department of Juvenile Justice under the Department of Health.

And that really was the thing that kind of hooked me.

It was really exciting, and it showed the way that when we think about how we address really big public health challenges like childhood adversity, we recognize that it has to be a public health approach.

I had been doing this work as a pediatrician and a clinician working in the community for a really long time, and people can be doing really good work, but if our systems are set up to make that more difficult, then what we will see is that we won't get to those transformative outcomes that our communities really need.

So that's why I kind of hit the ground running in my role as California Surgeon General, and I'm really pleased that since twenty twenty, when we launched the initiative to train clinicians to do early identification and evidence based intervention for adverse childhood experiences and toxic stress.

We've trained almost fifty thousand providers and more than four million ACE screens have happened in California, so it's we're doing the work at a big scale.

Yeah.

So I don't think I knew that about the departments you now just as being moved under the Department of Hell.

But it makes perfect since when I could you see it right?

But sadly, I do not think it is something that like more states have adopted, or at least not enough of them.

Can you talk more about the connection that you think is important to really highlight between Juvenile Justice and the Department of Hill.

Yeah, so, you know, I'll start by just backing up a second and just giving listeners a little bit of background on adverse childhood experiences.

And for me as a clinician, when I was taking care of patients in a very vulnerable neighborhood of San Francisco, a lot of patients were being referred to me for ADHD or attention deficit hyperactivity disorder, and I also observed that so many of my patients were experiencing just really difficult things at home.

And in the community, so they were being cared for by parents who were struggling with mental health disorders or substance dependence, where they were witnesses violence at home or in the community.

And when I started reading the research about how this affects kids developing brains and bodies, what I found in this there was this big landmark study from the CDC and Kaiser Permanente called the Adverse Childhood Experiences Study, And what they found was that number one, when they looked at ten categories of adverse childhood experiences and those include physical emotional or sexual abuse, physical or emotional neglect, or growing up in a household or a parent experience mental health disorder or substance dependence, incarceration, parental separation or divorce, or intimate partner violence, that those things were actually incredibly common, right, So two thirds of folks had experienced at least one one in eight folks had experienced four or more of those categories of aces.

And not only were they common, what they found was that there was a dose response relationship between these adverse childhood experiences and health outcomes.

So things like when I say dose response, I mean the more categories of aces someone had experienced, the higher their risk for things like heart disease, stroke, cancer, but also depression, anxiety, substance dependence.

And then we see this really powerful association between these aces and incarceration.

And we now understand that when we're in childhood and we experience some things stressful or traumatic, that activates our stress response.

Right.

Everybody's got their biological stress response.

Some people call it fight or flight, right, and that when kids are exposed to stressful or traumatic experiences too frequently or too intensely, it can actually change the way our biological stress response is wired.

And so we see prolonged activation of the stress response, and that we now understand is what leads to these increased risk of physical, mental, and behavioral health disorders.

So, at the time when Governor Newsom asked me to serve as California's first surgeon in general, part of the reason why it was so important for me to look at this in a really holistic way and the impact on our society is because a research study coming out of Florida showed that when they studied kids who were in the Florida juvenile justice system, they found that more than ninety per had experienced at least one ACE, and fifty percent had experienced four or more.

Right.

So, when we look at the impact of adverse childhood experiences and really the impact of what happens when someone has a dysregulated stress response and may have impaired impulse control for other difficulties, or increased risk of substance dependence or other things like that, it's making sure that we address the root cause so that we can prevent these later life negative outcomes.

And just seeing that the governor was willing to make that change for me, it reflected that he really understood that we have to target the root causes.

Doctor burg Harris, can you talk about the impact of like racism and discrimination on ACES, Like is there a category for that in the scale?

So that's a great question.

And in the original ACE study, it was done in a population that was seventy percent Caucasian, seventy percent college educated, right, And so they did not include exposure to discrimination as one of the ACE criteria, in part because that was not what they were seeing in their patient population, so they didn't think to include it.

But this is why the science is so important, And I'm going to confess that science is my love language.

One of the things that's really important.

And so people often ask me, like, isn't exposure to discrimination and ACE?

And I want to like, this is where the super science nerd in me is going to like pull things apart a little bit, which is that because it wasn't included in the original ACE criteria, I wouldn't call it an ACE, right.

But what we do know, and this is very clear, the science shows is that it is a risk factor for the development of a dysregulated stress response, right, which many doctors and clinicians now refer to as the toxic stress response.

And why that's an important distinction is because right now we have data from more than twenty countries that shows that, for example, an individual with four more ACES, their relative risk of ischemic heart disease is two point two right, So they're two point two times is likely to experience a Scheming cart disease.

And we're able to do those calculations and those analysis when we're looking at the traditional ACE criteria and we're looking at this health outcome, and so we can use that to say, okay, well, what's the cost of heart disease and how much of the heart disease that's out there is due just to aces, right, So the CDC has done this analysis.

When you use different factors, the ability to do those types of analysis rigorously is right, Like you have to compare apples to apples and oranges to oranges to be able to make those analyzes.

But what's important is that ass are a risk factor for developing the toxic stress response.

There are other risk factors for developing the toxic stress response, including exposure to discrimination, including for example, experiencing war, right, including things like being separated from your parent or caregiver through deportation or migration.

Right.

And what's important is that when we understand who is at risk for having a dysregulated stress response, then we can address that with evidence based interventions to help to regulate the stress response.

So it's really important that we are very rigorous with the science, right because you know the folks who there's always folks who say, oh, well that's real bogus, that's this, that's that.

And for those people, I love to be able to come with very hardcore analysis that really stands up to people trying to punch holes in it.

But what we understand, right, is that we understand that the treatment, right, the treatment is the same, and that's the piece that we have to work on.

Identifying who's at risk and someone is at increased risk if they've experienced discrimination, and then understanding what are the interventions that make a difference.

So let's dig into your love language of science a little more.

You've mentioned the term disregulated stress response, and it sounds like you talked about impulse control is something that is a bi product of having a disregulated stress response.

Can you talk about what a regulated stress response is and like, what does this look like in the brain when children and even adults are having a dysregulated stress response.

Yes, so, oh my gosh, this is so much fun.

So let's keep in mind that our stress response was designed to save our lives from a mortal threat, right, And the animals that didn't evolve a stress response, right, like, they didn't live to reproduce.

So when we think about when we talk about the stress response, one of the things I talk about a lot is like, imagine that you're walking in the forest and you see up there right, like what happens in our brain and body Immediately our brain's fear response center, which is the amygdala, it gets activated and it sounds the alarm, and it tells our brains and our bodies to release stress hormones.

And so we release adrenaline and cortisol and a whole bunch of other stress hormones.

And what happens in our bodies right, our hearts start to pound, right, our blood pressure and our blood sugar increases, and we shunt blood to our big muscles for running and jumping, and away from that anabity muscle that holds your bladder close, so you may pee your pants, but there's no judgment, right, so you can be ready to either fight that bear or run from the bear.

And that's why we often call it fight or flight.

Now, if you were to think about it, fighting a bear would not seem like a good idea because he's way bigger, he's got teeth and claws, right, all that stuff.

And so what actually happens in our brains is that the amygdala, the fear response center, sends projections, it sends nerve cells to this part of the brain up front.

It's called the prefrontal cortex, and it's responsible for impulse control, judgment, executive functioning, and it turns it way down, because the last thing you want if you are face to face with a bear is some impulse control getting in the way of survival.

And what it does is it turns up a part of the brain called the nor agenergic nucleus of the locus ceruleus, or as I like to call it, the part of the brain responsible for I don't know karate, but I do know crazing.

This is our within the brain stress response center, and it gets us amped up.

Now, the last thing that happens when we activate our stress response is that it also activates our immune response, because if that bear gets his claws into you, you want your immune system to be primed to bring inflammation to stabilize that wound so you can live long enough to beat the bear or get away.

So this is genius.

It was designed to save our lives from a mortal threat.

And then when that threat is resolved, it turns itself off.

It does something called feedback inhibition, which is a little bit like I would call it like the body's stress thermostat.

You know how you set the thermostat to whatever, let's say it's seventy degrees, and your system will pump out heat until it gets to seventy degrees and then it'll turn itself off.

That's how our stress response is designed, is that it gets activated and we release lots of stress hormones and when they get to a certain level, it turns itself off.

So children, because they typically aren't in control of their environments, they require a safe and caring adult to help them turn off their stress response system.

So safe, stable, and nurturing relationships are a fundamental prerequisite for children's healthy development.

And when children don't have that nurturing, buffering relationship to help turn off their stress response, what we see is something called loss of feedback inhibition.

So just imagine that the stress thermostat is broken and this stress response system gets activated, and instead of turning off when you reach certain levels of cortisol and adrenaline, it just keeps going and higher and higher and higher.

So I don't know if you know anyone in your life.

I can think of a couple folks that I'm thinking about who Number One, they can go from like zero to sixty really quickly, right like it's just huge levels of stress hormones just flood their system.

Number Two, you can see that the upset like kind of overshoots the mark, right, and it's wow, the response is really intense.

And then number three, it can take them a really long time to calm down.

And those are signs of a disregulated stress response.

And for some folks you can see it in like behavior and upset.

For some folks you won't see any behavioral symptoms.

What you'll see is, for example, they get sick really easily when they're overwhelmed.

Like, the issue is with their the responses with their immune system.

Right.

For some folks, it's like they experience something traumatic.

And this is one of the things that I saw in my patient population.

A child experiences something traumatic, and where you see the difference is in their hormonal response.

Right.

So for example, someone experiences a trauma and then they gain fifty pounds, right, or they stop eating, right, they and they either kids are not growing or adolescents may develop an eating disorder.

Right.

That's where we start seeing these changes.

So for some it's in their behavior, for some it's in their metabolism, for some it's in their immune system.

More.

From our conversation after the break and to burk Hare is like, how is toxic stress different from like the everyday stress that we might experience.

Yeah, so everyday stress is a normal and regular part of life, and it's actually kind of important for learning, and it helps us be able to figure out what to pay attention to and all of that good stuff.

The kind of the medical way that we assess toxic stress, right, is that it's associated with changes in brain architecture, So changes in the structure and function of children's developing brains and then on into adulthood, or changes in the immune system, the hormonal system, even the way our DNA is read and transcribed.

And so for example, what we see is that like homework, let's just give homework as an example, because people have asked me about that.

So homework for a lot of kids is stressful, right, But when we look at the data around kids who received homework and kids who didn't receive homework, we don't see increased risk of cardiovascular disease in kids who received homework, right, And so that's the place where we look at, is there a stressor does it biologically meet the criteria right where you have the stressor that kind of overwhelms the physiologic stress response and actually leads to a dysregulation of the biological stress response, and then does it also lead to increase risk of disease.

And so that's how we're able to assess whether it's kind of an everyday stressor or whether it's like a really severe stressor that leads to increased risk of toxic stress.

One thing that I want to say that's really important is that when doctors talk about the stress response, we talk about three different types.

So you've heard me talk about the toxic stress response, and that is when you have actually a change to the way that your stress response is wired that increases the risk for lifelong health challenges.

And then on the other side of that, when it's functioning normally, we call that the positive stress response.

Right, it's a good thing.

It's protecting you from danger.

And in between, when the stress is more more intense, right, or more severe.

But and this is key that kids receive adequate buffering caregiving structures, and I would advocate that the same is true for adults as well.

That the body's biological balance, what we call homeostasis, can actually recover.

And so that is what is called the tolerable stress response.

When we start to see increases in stress hormones maybe the beginning of symptomatology, but then the individual is wrapped with the right supports, the right care, and that helps the body to be able to regulate itself again.

And so that is the tolerable stress response.

And one of the things that's really important about that is that that's what we're trying to leverage because experiencing something stressful or potentially traumatic, we're not going to be able to prevent all of that, right, but we do know that with the right supports, the right scaffolding in place, that we can prevent the development of the toxic stress response through early detection, early intervention, and nurturing buffering care.

Let's stay with the early detection in kind of early intervention.

For doctor Burg here is so, what are your recommendations for like how often pediatricians and other people involved with kids are assessing for ACES.

Yeah, so I can tell you this is something that I feel so proud of Fields really so in California during my tenure as Surgeon General, we launched the ACES Aware Initiative, and essentially what we did was we took the research and I was on a committee for the National Academies of sciences, engineering in medicine, and one of the key findings looking at the impact of stress and health, and like the number one finding was early intervention improves outcomes.

That is like been proven in the science, right, early intervention and nurturing care can actually allow the brain to can actually change brain architecture.

Right.

Like if even in kids, for example, who were in groove homes, in like a foster care setting, when they got high doses of nurturing caregiving, we were able to see on MRI normalization of the white matter structure of kid's brain.

So we're talking about it really makes a difference.

And so, but the challenge is our system doesn't enable early detection, right, So most kids don't come to any attention unless they develop mental health sentimental.

And similarly, even if a child comes to attention, if you're a mental health provider or you're trying to provide the wrap round care the supports for the family, oftentimes, like in my clinical practice, we were doing this, but we couldn't build for mental health or support services if the child didn't have a mental health diagnosis.

Right.

So here we have a systemic structure that requires someone to be harmed before they can get access to care right, and that seems a little backwards, especially considering that the data is so strong about the risk of harm.

So what we did in as part of the ass Aware initiative was, in addition to training providers and how to screen for ass and training them on evidence based interventions to respond to risk of toxic stress right, we also in California made it so that a child could get access to services based on the result of their ACE screen and they didn't require a mental health diagnosis.

A child with four more ACES could get access to wrap around services paid for by Medicaid because rather than wait for them to develop physical health symptoms or mental health symptoms or as we started this conversation, right, rather than waiting for them to go into our juvenile justice system right, which again is going to cost us way more money.

We said, children can get access on the basis of the result of their ACE screen if they're identified at being at high risk of having a toxic stress response, and so we recommend and the way that we ruled it out in California was that providers could get paid for doing screening for kids once a year, so just typically at their regular physical and one of the things I think is really important about that is that when we launched it, initially folks thought like, oh wait, why isn't the screening happening, for example, at a mental health People thought, oh, yeah, no, we should be the screening should happen as part of a mental health visit.

But as we know, right if we're trying to do prevention, then if we're doing it at the mental health visit, that's going to be after someone's already symptomatic from a mental health standpoint, So we really want to do it as part of their regular well child exam, whether that's by a pediatrician or family physician, so that we can actually do prevention, which is the data shows that when we actually do early identification, early intervention, we can improve health comes.

So we've talked a lot about that homework study, right, like the very first study, but I would imagine there's been lots and lots of research done on ACES since then.

Can you talk about, like any of the research that talks about specifically like what ACES look like in the black community and how either intervention or detection might look different.

Yes, So one of the most interesting studies.

It was really eye opening for me was a study called a Strong African American Family Study, and they looked at aces and experiences of early adversity, and what they found was that for some folks, their exposure to early adversity was associated with increased risk of mental or behavioral health disorders.

But what they found in looking at this community of African Americans was that for the folks who didn't have any mental or behavioral health symtomatology, that when they measured what we call something that researchers call alistatic load.

It's essentially the effect of stress on your cells.

Right, Increased alistatic load is associated with increased cardiovascular disease.

It's literally the physical changes to your body.

Those who didn't have mental health symtomatology had a higher alistatic load, meaning that their physiology and their cells were more affected and that they had increased risk of chronic disease.

Part of the reason why that's so important is again because some folks say, like, well, you know, we should just be we should just be screening for mental health disorders and if someone has a mental health disorder, that's who should get care.

When we look at health disparities, particular in the African American community, right, and we look at rates of diabetes.

Okay, a person with four more aces, he has a seventy percent increased risk of diabetes.

Okay, when we look at cardiovascular disease, you know, all of these different things.

What we see is that are you familiar with the term John Henryism?

Right?

Where it's like John Henry like working on the railroad line.

So I may not remember it perfectly, but essentially it was the story of a laborer by the name of John Henry who was working on the railroad line.

And essentially he performed this like absolutely heroic fee of physical strengths in what he did, and then he dropped dead, right.

And so when people refer to John henryism, often they talk about the ability to perform or the ability to seem like we're okay and doing well, but really there's a profound internal toll that's not being measured.

And this is why the Strong African American Families study was so important because for many of the folks who don't have mental health or behavioral health symptomatology, they get no care.

They don't I'm just gonna say this because I was just speaking at a conference last week, I was at the Prevent Child Abuse America conference in in Portland, and I was giving the keynote address.

And I'm going to say that no fewer than fifteen people came up to me during that conference, either before or after I gave my talk, and they say, doctor Burcerris, thank you so much for your work.

What you described that was me I experienced.

And they told me, however many ass they had experienced and I didn't have mental health sentematology.

I had really bad headaches, I had really bad stomach pain.

I developed an autoimmune disease at this age, but I never had behavioral problems.

And this is I just like I'm so.

I hear it now so often that the notion that for me, it just our systems need to our systems need to get better.

Right.

We can't wait until someone has mental health sentomatology before we provide them services.

Well, can you talk a little bit about that, doctor Burghers.

I mean, because of course you are your training is as a pediatrician, so that's your ideal population.

But because a lot of people who will be listening to this and will who have heard your work recognize it themselves.

As a child right, like, oh my gosh, Like if I took this test, this is where I would score.

And so can you talk about what it looks like to kind of recognize that you maybe have high experiences of aces as an adult and what that looks like and how it might.

Present Yeah, and so I can talk about that and I will.

Honestly, I feel like it would be I don't know, it would be a mess for me to talk about it without talking about my own experiences.

I think part of the reason that I am so passionate about this work is because I myself really experienced a lot of aces, like significant number of aces, and it was really funny to me, because not funny as in humorous, but like when I came into this work, I came into this work for my patients.

I think that my own experience of aces, what that did for me was it made it intolerable that to just be leaving folks to kind of fend for themselves, that wasn't okay with me.

I think, because I know what it feels like to have these experiences and to really struggle, I think it was important to Like, when I started taking care of my patients, I was like, Okay, let me understand this better, what is the biology behind it?

And then how do we intervene?

And it turns out that the good news and this is why this work is so important to me, and I feel like it is so hopeful for anyone who has experienced aces, Like the ACE data is based on what happens when you experience aces and you get nothing right, And now there's been thirty years worth of research to say, what can we do?

So Number one, knowing that a dysregulated stress response is that what we're trying to treat is key.

Okay, So it's like, how do we regulate the stress response?

And one is things like so number one is safe, stable, and nurturing relationships and environments, right, that is absolutely key.

And I think that one of the things that's tricky.

It's easy to say, but I will say it's another thing to do because one of the things that gets really tricky is that if you grow up in an environment where there was a lot of chaos, or where you really loved your parent or caregiver, but your parent or caregiver was also the source of a lot of drama and harm, verbal abuse or physical abuse, right, then we get in like our nervous system can really become wired to kind of intermingle intimacy with chaos and violence, really, right, Yeah, and so we have to unlearn that.

So that's one of the reasons why therapy is so important.

Therapy is really key, and it helps us learn how to keep ourselves safe.

I think one of the things that's really tricky is that when you're a kid and you don't have you don't have the capacity to keep yourself safe.

We sometimes learn some coping mechanisms that are intended to try to keep us safe that we bring into our adult lives, right, And so there are times when we have to when we look at how we're reacting and how we're responding to a situation.

And it's really helpful to have someone like a professional to check in with and say, like, WHOA, I had this experience, because this is what's key.

We know that when we experience, you know, stressful autumatic experiences in childhood, when we're exposed to something that reminds of us of those experiences, that can be a trigger and then you get the full activation of your biological stress response with those triggers.

And so every time my biological stress response gets activated.

That also increases our risk for health, ment, health and behavioral health challenges.

Right.

And so even though whatever it was happened when we were kids, our biology is still responding as though that's what's going on today, right, And so we see things like safe, stable, and nurturing relationships and environments mindfulness, like meditation that helps to strengthen the parasympathetic nervous system, which is like the resting and digesting, and it counteracts the fight or flight response.

So really strengthening our ability to counteract our fight or flight response is really important.

Exercise is really important, So daily exercise to be able to burn up those stress hormones and also to strengthen the release of endorphins and other feel good hormones that counteract our stress hormones.

Time in nature.

I don't know if you've ever experienced this, but getting out into nature going for a high is like a combination between exercise and but one of the things that I learn from my mental health colleagues is something called coregulation.

You probably know this a lot better than I do, which is actually part of what happens when kids are supported by safe, stable, and nurturing folks.

It's that you.

If you're regulated, then the child will calibrate their nervous system to how you are right, and we can we can co regulate with nature, right like just being in experiencing nature actually helps to reduce the activation of the fight or flight response and increase the activation of the parasympathetic the resting and digesting.

So sleep, exercise, nutrition, mindfulness, mental health, healthy relationships, and time in nature are some of the key interventions.

And I should say I talk a bit more about this for folks who are looking for resource and my book The Deepest Well, which kind of for folks who want to do more of a deep dive and understanding a little bit about how toxic stress works and what things help to counteract it.

More from our conversation after the break.

So I am hereious, doctor Burke Harris.

Are you aware, and it may be too soon for this, Are you aware of any research that's been done related to aces in the pandemic?

Because when I think about, you know, like that period of time where it felt very much like a bear is chasing us, right like, oh my gosh, what's happening?

It feels like a time when the stress thermostad like you weren't sure how to.

Turn it off.

Are you aware of any research that's been done there in terms of kids and aces?

Yeah?

Yes.

So I was working in the California Surgeon General's office when the COVID nineteen pandemic hit, and I remember when we were getting ready to issue the remain at home orders, and you know, we had epidemiologists and disease modeling specialists and infectious disease specialists looking at this, and I was looking at something else, and I was just like, wait a minute, if we're this is a major stressor, right, there's a lot of people who if we're getting ready to issue remain at home orders, the biology of stress physiology can just tell us.

So we can predict now that stress related health conditions are going to increase, right.

And I actually wrote a memo to the governor and was just like, hey, we need to get ahead of this because we're about to see this increase.

And what we saw was and by the way, this data has been shown in other natural disasters as well, right, so from Hurricane Katrina to earthquakes in Japan to stars and mers like we see that when there is a major public health emergency that stress related health disorders can increase, right, And so there was actually global data that was published in twenty twenty one that showed that between twenty nineteen and twenty twenty one, anxiety global rates of anxiety and depression among youth doubled across the world.

Okay, now, obviously it wasn't that all of a sudden twice the number of children and youth had a netic predisposition to depression anxiety.

It's that we have this massive stressor that predictably activating the biological stress response.

We also saw that that initially in the pandemic, we saw rates of child maltreatment going down, which likely because they were not being reported right like kids are not at schools or in other places where where reports would come from where concerned adults would see it and be able to make a report.

But what we did see was that the severity of injury and the hospitalization rate from child maltreatment went up.

So we see that the number of kids being hospitalized for child abuse essentially went up.

And so we definitely saw this, and this is part of the reason why it was so important that we put into place these initiatives to do early detection and evidence based intervention with the supports that we know help to regulate the stress response and help to prevent these long term harms.

You've already talked a lot about, like why you think at the policy level we should be addressing some of this.

What kinds of policies and systemic kinds of things do you think would be important for states and governmental institute to really focus more on, like a prevention early intervention As we're thinking about ACES.

It's really important for our policies obviously to be supported by the science.

I actually right now I'm working with a team to help other states that are interested in implementing the ACES aware a model to provide them with the technical assistance and the expertise to be able to do that.

Right.

But essentially, when we think about the ACE is aware model focuses on early detection so that we can do early intervention, which is really important.

But that's part of a spectrum, right, Like number one is prevention.

We want to prevent ACES and other risk factors for toxic stress, including discrimination.

Right.

So, I think it's super clear now that understanding how ACES and other risk factors for toxic stress impact health is massive, And the CDC actually published a report of the cost of ACES to the United States and estimated the cost at around fourteen point one trillion dollars annually.

Right, that's massive, Like, that's just absolutely massive.

And when we look at that cost, of course, when they did that analysis, they looked at a lot of things.

They looked at IRS data, they looked at Department of Justice data, they looked at Department of Education data.

So it's not just the health outcomes, but all of the all of the costs, all of the social costs that are associated with ACES.

So that's just astronomical.

So when we think about that, right, that huge amount of money.

Again, I think that for policymakers, regardless of what side of the aisle you're on, Right, So for nowadays it feels like our society is so polarized, but I think there's a lot of room for folks to agree that preventing ACES and other risk factors for toxic stress, doing early detection and effective intervention and then treatment obviously for the ACE associated health conditions, that is, that is what a full continuum looks like.

Right, Like I can just say from being on the front lines of our COVID response that we weren't just like, Okay, if someone gets COVID, we're gonna, you know, we're gonna treat them.

We're gonna put them on a ventilator or whatever.

Like we're gonna wait until they get We're like, whoa whoah.

No, we got to prevent it.

So we got a distance, So we got to wash our hands out, we got to wear masks, we got to do all that stuff.

Then testing, right, like, we got to make sure that folks can get tested and they know that if they are positive, they're going to try to prevent it the spread to others.

And we got to give people ppe, you know, personal protective equipment, all of that stuff.

That's what a full public health was spons looks like right prevention, early detection, and intervention, and we want that intervention to be as early as possible and as evidence based as possible, and ultimately right vaccines made such a huge difference with COVID.

And similarly, when it comes to this public health issue, when we're talking about two thirds of Americans have experienced at least one ACE, right, then when we're talking about policies, those policies involve preventing aces from happening to begin with, and that means like supporting families, making sure that parents or caregivers are able to you know, are supported to provide safe, stable, and nurturing relationships and environments, doing that early detection, and covering early intervention, making those services available.

Right, So, all of those pieces are necessary as part of a policy strategy to address ACES and toxic stress.

Doctor Burke Harris, what gives you hope about the future of this work?

Oh, my gosh, so much, I would say, what gives me hope?

Number one is that So when I started doing this work, I started screening my patients for ACES in two thousand and nine, right, so it's twenty twenty five now.

And at the time that I started doing that, I would go give a talk and I'd be speaking to a room of a thousand people and I'd say, how many of you have heard of ACES or toxic stress?

And three people would raise their hands literally, right.

And between that time and where we are today, I have just seen a transformation.

I have seen number one, more and more people being aware of this issue.

And it started with folks being aware and initially the response was kind of like, Okay, what can we do on this personal level, which is really important?

Right, So like how do we address it?

You know, how do I address up for myself?

What do I do?

And that's frankly that's where I started too, like what do I do with my patients?

What are these evidence based interventions?

And then as those become more widely known, I think folks have really taken to looking at our systems and saying, Okay, wait a minute, how do we set up our systems so that we can respond systematically at scale with these evidence based interventions?

Because I think before people were thinking like, okay, you have ass and you have increased risk, but is there anything you can do about it?

Right?

I think now we're past that.

I think the science is clear that there is actually a lot that we can do that when we apply these evidence based interventions, we actually can improve outcomes for folks.

And so just like the fact that between science and technology and research, when we come together and we make this a priority and we raise our voices and we advocate, we actually can transform our systems.

And that's what makes me excited and gives me hope.

Thank you so much for the doctor bird Cares.

It has been such a pleasure to hear so much more about your work.

Please let us know where we can stay connected with you.

What is your website as well as any social media channels you'd like to share.

So I'm like big on Insta, which is where I share updates and also all of my gardening tips because gardening is my self care and it is what brings me so much joy.

So that's at doctor Burke Harris on Insta and also Nadineburgharris dot com is my website and so folks can can look there to follow more about my speaking and other stuff.

Perfect well, we should include all of that in the show notes.

Thank you so much for spending some time with us today.

I appreciate it.

Oh, it's been my privilege.

Thank you so much for having me.

Absolutely, I'm so glad Doctor Burke Harris was able to join us for such an insightful conversation today.

To learn more about her and her work, be sure to visit the show notes at Therapy for Blackgirls dot com slash Session four three to two, and don't forget to text two of your girls right now to tell them to check out the episode before we go.

I also want to highlight another important conversation from our archives.

In session three seventy six, Sexuality as We Age I was joined by doctor Schera malone one who shared powerful insights about embracing our sexuality throughout life.

And now doctor Sharon has just launched her very own podcast, The Second Opinion with Doctor Sharon, where women take back the conversation on health with honesty, expertise, and the care we all deserve.

Make sure to check out our earlier conversation in session three seventy six and then subscribe to her new show wherever you get your podcast.

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This episode was produced by Lise Ellis, Indechubu and Tyree Rush.

Editing was done by Dennison Bradford.

Thank y'all so much for joining me again this week.

I'll look forward to continuing this conversation with you all real soon.

Take good care.